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General NPI Number Information
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NPI Number | 1467850891
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Entity Type | Individual
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Provider Name | MARY BETH RUCKI CRNP
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Gender | Female
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Dates
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Enumeration Date | 12/17/2014
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 1200 ASHWOOD DR SUITE 1201
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City | CANONSBURG
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State | PA
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Zip | 15317-4982
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Country | US
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Telephone | 724-884-0466
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Fax |
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Provider Business Mailing Address
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Address Line | 210 LARUE DR
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City | MOON TOWNSHIP
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State | PA
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Zip | 15108-1154
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Country | US
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Telephone | 412-749-7214
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP014309
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License Number State | PA
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